Provider Demographics
NPI:1316680457
Name:HURT, BENTON LEE (DO)
Entity type:Individual
Prefix:
First Name:BENTON
Middle Name:LEE
Last Name:HURT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 I STREET
Mailing Address - Street 2:HP402
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547
Mailing Address - Country:US
Mailing Address - Phone:615-761-6200
Mailing Address - Fax:
Practice Address - Street 1:165 I STREET
Practice Address - Street 2:BUIDLING 402
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:25847
Practice Address - Country:US
Practice Address - Phone:910-449-8846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102208072171000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider